Erika Fruscella

The use of contrasted transvaginal sonography in the diagnosis of gynecologic diseases: a preliminary study.

The purpose of this study was to evaluate the efficacy of a new contrast‐dedicated ultrasound technology, contrast‐tuned imaging (CnTI), implemented on an endovaginal probe and using the second‐generation contrast agent SonoVue (Bracco International BV, Amsterdam, the Netherlands), compared with the standard ultrasound examination in different gynecologic diseases.

Chemoprevention of DMBA-induced mammary cancer in rats by dietary soy

This study was designed to assess the potential chemopreventive effect of the administration of a standardized soy extract, SOYSELECTTM, on 7,12-Dimethylbenz[a]anthracene (DMBA)-induced mammary tumors in rats. Three groups, 24 females each, were used. Animals were fed either a phytoestrogen-free diet alone (control) or the same diet supplemented with 0.35% or 0.7% of soy extract. Treatment started at weaning and continued to the end of the study (24 weeks after DMBA administration). At day 50 of age all animals received via oral gavage 80 mg/kg DMBA. Only tumors subsequently classified as adenocarcinomas were considered for data evaluation. In rats on the soy diet, mammary tumors took a longer period of time to develop as compared to control rats. However, at the end of the study, no relevant difference in tumor incidence and multiplicity was observed among the groups. The most significant changes were seen between control and soy-treated groups when tumor dimension and results from histopathologic examination were considered. The latter, in fact, showed a dose-dependent reduction in the percentage of poorly differentiated tumors in treated animals. This change was statistically significant in animals receiving 0.7% soy. In addition, assessment of estrogen and progesterone receptor (ERα, PR) levels, revealed a significant reduction in the percentage of ERα and PR positive tumors in animals receiving 0.7% dietary soy, when compared to controls. Interestingly, genistein and daidzein plasma levels determined at the end of the study were within the range of those detected in people consuming large amounts of soyfoods.

Gemcitabine: current role and future options in the treatment of ovarian cancer

Epithelial ovarian cancer is the gynecological malignancy with the highest mortality. The standard therapeutic approach for patients with advanced-stage epithelial ovarian cancer has been cytoreductive surgery followed by combination chemotherapy. Despite improvements in outcome via carboplatin/paclitaxel based chemotherapy, 30% of patients with ovarian cancer fail to respond to primary therapy; moreover, 55-75% of responders relapse within 1 or 2 years from the end of primary treatment and die of the disease within 5 years from their initial diagnosis. Gemcitabine has been shown to be active as a single agent and in combination with other drugs, including carboplatin and paclitaxel, in the treatment of patients with recurrent ovarian cancer. It is currently under evaluation in new combinations for initial therapy in ovarian cancer patients.

Angiographic Power 3-Dimensional Quantitative Analysis in Gynecologic Solid Tumors Feasibility and Reproducibility

Objective. To determine the reproducibility of a simplified method of power Doppler 3‐dimensional (3D) sonographic examination. Methods. Twenty‐nine patients with solid pelvic masses underwent transvaginal 3D power Doppler evaluation. The volume of interest was obtained by drawing the margins of the largest section of the mass in the 3 orthogonal planes. The 3D vascular parameters (“relative color,” “average color,” and “flow measure”) obtained by our method were compared with those calculated by a manufacturer‐suggested model based on several parallel section planes drawn on the longitudinal frames. The intraobserver variability was quantified on 5 different 3D images acquired by the same operator at 5‐minute intervals for each patient. The intraobserver variability was also assayed in 10 patients at 24‐hour intervals. Ten patients were scanned by a second sonographer for interobserver variability. Results. There was high agreement between the 3D parameters obtained with the 2 methods. The 3D indices were similar in repeated observations at 5‐minute intervals (median coefficients of variation for relative color, average color, and flow measure, 10.9, 4.5, and 13.0, respectively) and at 24‐hour intervals (intraclass correlation coefficients for relative color, average color, and flow measure, 0.920, 0.978, and 0.978) and by the second sonographer (interclass correlation coefficients for relative color, average color, and flow measure, 0.978, 0.966, and 0.997). Conclusions. The acceptable rates of intraobserver and interobserver variability make this approach potentially suitable for research protocols.

Dietary soy modulation of biochemical parameters in DMBA-induced mammary tumors.

The aim of this study was to extend our previous observations on the soy modulation of biochemical parameters in 7,12-dimethylbenz[a]anthracene (DMBA)-induced rat mammary tumors, by simultaneously investigating the expression of estrogen receptor-alpha (ERalpha), estrogen receptor-beta (ERbeta), progesterone receptor (PR), apoptosis, neu, and markers of cell proliferation, such as proliferating cell nuclear antigen (PCNA) by immunohistochemistry. The percentage of ERalpha positive tumors was 65.8% in masses from control animals, and significantly dropped to 36.8% in tumors from soy treated rats (P=0.010). The percentage of ERbeta positive tumors was 70.3% in masses from control animals vs. 50.0% in tumors from soy exposed animals (P=0.066). Moreover, the percentage of cases which were both ERalpha and ERbeta positive was significantly lower (17.6%) in soy treated than in control animals (51.3%) (P=0.006). The percentage of PR positive tumors was 34.2% in control animals vs. 2.6% in tumors from soy treated rats (P=0.0006). There were no statistically significant differences in the percentage of tumors positively stained for neu, apoptosis, or PCNA, in control vs. soy treated rats. However, when analyzing the reciprocal correlation among the different biochemical parameters we showed that, in treated animals, the majority of ERalpha positive tumors (91.7%) were also PCNA positive (P=0.036). The median percentage of PCNA positivity was significantly higher in ERalpha positive than in ERalpha negative tumors (25 vs. 5%) (P=0.0031). Moreover, an association was found between PCNA and neu status since all neu positive tumors were also PCNA positive (P=0.011).

Growth inhibitory effects and radiosensitization induced by fatty aromatic acids on human cervical cancer cells.

Evidences have been reported that phenylacetic (PA) and phenylbutyric (PB) fatty aromatic acids can exert tumor growth inhibition in vitro and in vivo. Moreover, clinical trials also showed some activity for these drugs to modulate the expression of genes implicated in tumor growth, metastasis, immunogenicity, and to potentiate the efficacy of cytotoxic agents. The aim of the study was to examine the effects of PA and PB on the growth as well as sensitization to cisplatin and radiation in human cervical cancer cells. The effects of PA and PB on the proliferative activity and apoptosis induction in cervical tumor tissue was investigated. Both PA and PB exhibited a time- and dose-dependent antiproliferative activity in SW756 and ME180 cell lines: after 72-h treatment, the IC50 (concentration able to inhibit 50% of cell growth) of PB was 1.9 +/- 0.2 mM and 1.5 +/- 0.2 mM in SW756 and ME180 cells, respectively, while the IC50 of PA was 13.0 +/- 1.7 mM and 10.0 +/- 1.2 mM in SW756 and ME180 cells, respectively. In tumor tissue biopsies obtained from patients affected by squamous cervical cancer, both drugs resulted in a marked reduction of the percentage of bromodeoxyuridine-labeled cells compared with untreated samples [19.0 +/- 1.63% in untreated tissues with respect to 1.30 +/- 0.54% and 4.20 +/- 2.50% of stained cells after treatment with PA (30 mM) (P < 0.0001) and PB (5 mM) (P < 0.0001), respectively]. Moreover, analysis of the staining with M30 monoclonal antibody revealed that PA (30 mM) and PB (5 mM) were able to produce a marked increase in the number of stained apoptotic nuclei with respect to untreated samples. Finally, PB and PA were shown to enhance the sensitivity of SW756 to radiation and to exert an additive effect when combined with cisplatin. A significant reduction of the processed form of p21ras and rhoB proteins in the membrane fraction of cells exposed to PA and PB was observed. When farnesol, which is able to circumvent the enzymatic step inhibited by PA and PB, was added to the medium only a partial reversal of the growth inhibition and potentiation of sensitivity to radiation induced by PA and PB were found. In conclusion, the growth inhibitory properties of fatty aromatic acids suggest that these molecules could represent the prototype of a new class of compounds with some therapeutic potential in cervical cancer.

Ultrasound and color power Doppler in the detection of metastatic omentum: a prospective study

To analyze prospectively the ability of ultrasound to detect metastatic omentum in patients with suspicious pelvic masses and to describe the sonographic features of metastatic omental disease.

OC164: Ultrasound contrast examination to discriminate benign and malignant adnexal masses

A. C. Testa1, D. Timmerman2, E. Fruscella1, C. Van Holsbeke2, L. Savelli3, E. Ferrazzi4, F.P.G. Leone4, H. Marret5, C. Exacoustos6, G. De Placido7, D. Bokor8, G. Ferrandina1, V. Van Belle9, L. Valentin10 1Università Cattolica del Sacro Cuore, Rome, Italy, 2University Hospitals, Leuven, Belgium, 3Reproductive Medicine Unit, Bologna, Italy, 4DSC L. Sacco Università di Milano, Milano, Italy, 5Unité INSERM CHU Bretonneau, Tours, France, 6University of Tor Vergata, Rome, Italy, 7University of Naples, Naples, Italy, 8Bracco S.p.A., Milano, Italy, 9Dept Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven, Leuven, Belgium, 10University Hospital, Malmo, Sweden

OC196: The contribution of CNTI-SonoVue in the classification of adnexal masses as benign or malignant: a multicenter study

I concentration. Cardiac troponin I (cTnI) is a specific marker of myocardial injury in adults and children. Perinatal asphyxia can cause cardiac dysfunction. Methods: Some 161 samples among fetuses from pathological pregnancies were collected. Twenty-two had an elevated level of cTnI (above 0.1 ng/mL). Disorders in pregnancy, date of gestation, Doppler flow velocimetry in the ductus venosus (DV) and umbilical artery (AU) and vein (DV), mode of delivery, Apgar score and respiratory status after birth were evaluated. cTnI was determined on a dimension clinical chemistry system. Results: There were 22 newborns with a raised level of TnI: seven (31.8%) with SGA, five (22.2%) with fetal cardiac problems (arrhythmia, structural and functional abnormalities), nine (40.9%) with abnormal biophysical test results (abnormal Doppler velocimetry, computerized cardiotocography, biophysical profile score) and six (27.2%) whose mothers who had disorders (diabetes mellitus, hypertension). Results are shown in the table. Median gestational age at delivery was 36.6 (range, 27–43) weeks. Seventeen (77.2%) patients had a Cesarean section. The range of TnI blood concentration was 0.11–6.66 ng/mL in this group. Five (22.7%) had umbilical pH below 7.25. Conclusions: A high level of cTnI was associated with several disorders that could have led to fetal asphyxia. More detailed fetal heart examination is necessary to prove that fetal asphyxia had an impact on heart function.

P22.03: Ultrasound and color power Doppler examination in the detection of metastatic omentum: a prospective study

We describe and present the rare echinococcus disease of the genital tract in a 62 year old female patient. The patient suffered previously and has been operated for lungs and liver echinococcus cysts. She complained for abdominal non-specific diffuse pain and a feeling of abdominal dilatation. She was examined with an abdominal and endovaginal ultrasound Doppler procedure and an enlarged characteristic fixed echogeneous cyst was depicted of more than a hundred millimeter diameter without any vascularisation across its wall thickness. The RI was more than 0.40 in all measurements at the areas where the cysts have been infiltrated in the neighboring organs. The echinococcus anti-body reaction test was positive. The patient followed an abdominal surgical procedure with success and the pathology description which followed was positive for echinococcus disease. Even it is too rare the depiction of echinococcus cysts we present the main characteristics of them in comparison to dermoids or cystadenomas malignant or benign ones also by Doppler application procedure. A careful history during the ultrasound examination is necessary to lead us to diagnosis of even today rare disease by application of Doppler ultrasound.